ED Coding and Reimbursement Alert
List Worst Fracture First
Question: Which diagnosis code should I list as primary when a patient has multiple fractures?
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Answer: Report any fracture that is open or complicated by debris as the primary diagnosis. If you have multiple fractures that fall into that category - or none at all - you should report the fracture for the largest, longest bone first.
For example, you should report a pelvic bone fracture (808.2, Pubis, closed) before an ulna bone fracture (813.01, Olecranon process of ulna), unless the ulna fracture is open or complicated by debris (813.11, Olecranon process of ulna; upper end, open).
If none of the fractures are open or complicated by debris and the bones are relatively the same size, report the fracture that required the most work from the physician. If you have a broken metatarsal (826.0, Fracture of one or more phalanges of the foot; closed), a broken tibia (823.00, Fracture of tibia alone; upper end, closed), and a radial ulna fracture (813.44, Fracture of radius with ulna, lower end) that the doctor must reduce due to dislocation, you should report the radial ulna fracture first (assuming the physician provides definitive care for each).
ED Coding and Reimbursement Alert
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